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What is Complex PTSD?
While post-traumatic stress disorder (PTSD) is frequently linked to a single particular traumatic event or experience, complex PTSD, or c-PTSD, is an anxiety disorder brought on by ongoing or persistent trauma. It was initially used to explain the effects of childhood trauma. Although, it is now associated with other kinds of chronic trauma.1
Currently, complex PTSD is not recognized as a distinct disorder in the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5), a guidebook often used by psychiatrists and psychologists. Yet, the illness is recognized by the World Health Organization’s International Classification of Diseases, 11th Revision (ICD-11), and some medical professionals are diagnosing it.2,3
|Typically caused by chronic, recurrent trauma||Typically caused by one specific occurrence|
|Frequently happens among those who have experienced racism and oppression||Can occur as a result of trauma at any age|
|Usually develops from adverse childhood experiences (ACEs)||Typically less severe than C-PTSD|
|Generally worse than PTSD||Recognized in the DSM-5 and the ICD-11|
|Recognized only in the ICD-11|
- Those with complex PTSD frequently experience repeated or prolonged trauma, such as child abuse and domestic violence.
- 1-8% of the general population and up to 50% of patients in mental health facilities are affected by the condition.4
- Between 0.5% and 3.8% of the population may be affected by c-PTSD at any moment. According to estimates, 7.3% of people will have c-PTSD at some point in their lives.5
- In addition to having a higher chance of developing complex post-traumatic stress disorder than men, women are more likely to have psychological distress and functional impairment.6
- Acculturative pressures and social context may worsen complex post-traumatic stress disorder for immigrant groups, particularly refugees or asylum seekers.
- Many people with complex PTSD may also fit the borderline personality disorder (BDP) diagnostic criteria.
- According to studies, around 3% of Americans are believed to have complex PTSD.7
- A staggering 92% of patients with c-PTSD also meet the criteria for PTSD.8
- A 2015 study published in Clinical Psychological Science found that between 0.6% and 13% of military veterans who have experienced trauma may have c-PTSD.9
Symptoms of Complex PTSD
The symptoms of PTSD and c-PTSD are very similar, but c-PTSD also has three additional categories of symptoms: problems controlling one’s emotions, a diminished sense of self-worth, and interpersonal issues, which can appear as some of the following (although it’s important to note that people with PTSD may also experience these additional symptoms):10,11,12
- Self-esteem issues/negative view of oneself
- Feeling worthless, shameful, or guilty
- Problems managing emotions
- Finding it difficult to connect with others
- Relationship issues, such as difficulty keeping friendships and romantic partnerships
- Dissociation, or being cut off from one’s feelings
- Having trouble perceiving reality
- Loss of your beliefs
- Skewed worldview
Causes & Risk Factors for Complex PTSD
Complex PTSD may result from enduring persistent or chronic stressful situations, such as:
- Child abuse or neglect
- Domestic abuse
- Sexual assault, torture, sex trafficking, or acts of enslavement
- Prisoner of War (POW)
The following may make someone more susceptible to developing c-PTSD:
- You were harmed by someone you trusted, like a family member
- You experienced trauma when you were young
- You were unable to get away from the trauma
- Underlying mental health disorders, such as anxiety or depression, or a family history of it
- Inherited personality traits
- How hormones and neurochemicals in your body are regulated, particularly in response to stress
- Lifestyle factors, such as an inadequate support network or a dangerous job13
In addition, there is evidence that repeatedly experiencing racism may traumatize Black people, Native Americans, and other people of color. Furthermore, groups frequently targeted by hate, like the LGBTQ community, are susceptible to developing c-PTSD. Further investigation is being done to decide how to classify this type of trauma.14
The data indicate that the duration of the traumatic exposure is more closely associated with c-PTSD than the age at which it happened. This is contrary to the initial focus of childhood trauma causing c-PTSD.
The precise method by which trauma alters the brain and causes disorders like c-PTSD is still a mystery to researchers. Yet, animal research indicates that the amygdala, hippocampus, and prefrontal cortex may be permanently altered by trauma. These regions have a significant impact on how well our memories work, as well as how we react under pressure.15
When to Seek Counseling for Complex PTSD
Mental health professionals may diagnose patients with PTSD rather than complex PTSD because the disorder is still relatively new and isn’t listed in the DSM-5. There is no test to distinguish between the two conditions.
When diagnosing complex PTSD, a physician must decide if the patient satisfies all requirements for traditional PTSD per the ICD-11. In addition, the individual must exhibit issues with self-control, low self-esteem, shame or guilt associated with past trauma, and difficulties maintaining relationships with others.16
Suppose you’ve experienced trauma affecting your everyday life and routine functioning. In that case, it strongly indicates that it may be time to seek complex PTSD treatment.
Insurance may be able to help cover the cost of therapy. Find out if your insurance provider can help with the costs by filling in our confidential insurance verification form below.
Treatments & Therapy for Complex PTSD
Despite the disorder’s complexity and severity, c-PTSD is treatable using many of the same methods of treatment for PTSD. Therapy for complex PTSD, however, typically lasts longer.17
According to research, multicomponent treatments emphasizing patient-provider collaboration, safety, and psychoeducation are advised. Other recommended therapy components include self-control techniques and trauma-focused interventions.18
Complex PTSD treatment can include one or a combination of the following:
- Cognitive Behavioral Therapy (CBT): CBT targets current issues and symptoms, focuses on the connections between ideas, feelings, and behaviors, and aims to change negative thoughts, feelings, and behavior patterns that make functioning difficult.29
- Cognitive Processing Therapy (CPT): With this c-PTSD therapy, you’ll learn how to change and disprove false beliefs about the trauma.
- Prolonged Exposure Therapy (PE): PE lets you gradually approach upsetting memories, emotions, and situations. By confronting what has been avoided, you will likely discover that the traumatic memories and cues are safe and do not need to be avoided.
- Dialectical Behavior Therapy (DBT): DBT is frequently utilized as the initial therapy for borderline personality disorder (BPD). Trauma can cause BPD and c-PTSD, resulting in depressive moods and suicidal thoughts. Also, those who experience these disorders may establish a pattern of destructive behavior.20 It is also possible to have both BPD and c-PTSD. DBT, which is based on CBT, is a skills-based treatment particularly tailored for those who feel exceptionally intense emotions.
- Eye Movement Desensitization and Reprocessing (EMDR): Eye movements are used in conjunction with psychotherapy in EMDR. Building trust and introducing eye movement methods are the first steps in treatment. EMDR processes traumatic experiences and their memories until they are no longer upsetting.
To address severe symptoms, some doctors advise residential treatment. Yet, it might not always be required, nor is it always possible. In any event, for healing to occur, establishing a solid therapeutic bond is necessary. Individuals with c-PTSD frequently have trust issues. Building trust in other relationships might start with learning to trust a secure and empathetic professional, like a therapist.
Regaining a sense of self is a goal of complex PTSD therapy. Repeated trauma can harm one’s self-esteem and sense of identity. Personal objectives and ideals may also be impacted. Psychotherapy’s goal is to make processing that trauma easier. It assists with helping you recognize and change the adverse emotional effects trauma has had on your life.
C-PTSD therapy can give you room to:
- Reconnect with yourself
- Overcome false assumptions and self-blame
- Explore ways to end self-isolation
- Work through ideas of retaliation
- Address any unhealthy relationship ideas that may arise
It’s important to find a PTSD mental health specialist with experience and training in treating others with your condition. This professional must have a graduate degree in psychology to work as a trauma therapist. After earning that degree, they obtain real-world experience working with trauma survivors and keeping up with the newest developments in trauma treatment.
Additionally, therapists specializing in complex PTSD may have extra education or certification in trauma-informed treatment methods, such as cognitive processing therapy (CPT).
To help treat PTSD and c-PTSD, healthcare professionals frequently recommend medications.
They might include antidepressants, such as Prozac or Zoloft, and other types. However, it’s important to remember that while certain drugs can assist with specific c-PTSD symptoms, they don’t treat the actual disorder. Instead, they treat specific symptoms associated with the disorder, including anxiety and depression.
You and your doctor may choose which medication will treat your symptoms and situation with the fewest adverse effects. Before finding the correct prescription, you might need to try more than one, a combination of medications, or your doctor might need to change the dosage or schedule. Within a few weeks, your mood and other symptoms may improve.21
Complex PTSD Therapy Costs & Insurance Coverage
In the U.S., cognitive behavioral therapy sessions often last 45 minutes or more and cost between $100 and $200, dependent upon the state and the length of the session. In addition, EMDR therapy runs anywhere from $100 to $250 each hour/session.22 Each session lasts around 45-90 minutes. Remember that numerous sessions will be required, and each session is charged separately, bringing the total for EMDR to $800 to $2,000, on average, to reach desirable c-PTSD treatment outcomes.23
Despite the possibility of insurance coverage for medications, those without insurance or with high deductibles might be concerned about cost. Keep in mind that many insurance policies still limit coverage to specific drug classes, dosages, or just the generic form and not the brand name.
For example, the price of an average monthly supply of regularly prescribed antidepressants can range from a few dollars to several hundred, depending on the dosage. Generic versions of medications often cost around $5 to $25 per month.24
The Affordable Care Act requires most private health insurance policies to provide coverage for mental health treatment. The cost for complex PTSD treatment may be partially or entirely covered, depending on several factors, including your specific health insurance plan, location, and deductible or lifetime limits. In addition, you may be responsible for a copay. Therefore, the above costs may not reflect the actual price you’ll pay for complex PTSD treatment in Tennessee.
Athena Care has multiple PTSD therapy clinics in Tennessee, and we are in-network with most major insurance companies. Filling out our free, no-obligation online insurance verification form is the best method to determine if your insurance covers complex PTSD therapy in Tennessee.
Allow our highly skilled care coordinators to handle the hassles of contacting your insurance company for more information about c-PTSD therapy. A care coordinator will review your insurance policy and thoroughly explain your options after you’ve submitted the form. Rest assured that all information shared or discussed is kept entirely confidential.
Treatment Success & Outlook for c-PTSD
Complex PTSD recovery requires time. For many patients, c-PTSD is a chronic disorder that is difficult to treat and involves long-term, sometimes lifetime, care. Yet, using both therapy and medication alongside lifestyle modifications can significantly enhance your quality of life and successfully manage or lessen your symptoms.
Below are a few c-PTSD treatment statistics:
- After eight days of rigorous trauma-focused therapy, most patients—more than 85%—diagnosed with Complex PTSD no longer met the diagnostic criteria.25
- According to one study, intense EMDR therapy is an effective complex PTSD treatment that dramatically reduces symptoms in individuals with many or severe comorbidities without significantly exacerbating symptoms.26
- Individuals with c-PTSD responded to PTSD therapy equally. Still, additional treatment strategies should be considered, given the propensity for those with c-PTSD to remain highly symptomatic after treatment.27
Rushing the c-PTSD treatment process might do more harm than good. Short-term therapies do not offer the continuously secure therapeutic environment such patients require since complex trauma alters one’s attachment style, identity, and worldview.
Positive indications that complex PTSD therapy is working include when you spend less time remembering the upsetting memories, less effort attempting to forget them, or when you feel more confident in yourself. In addition, complete remission, or the capacity to go through the day without being hindered by the symptoms of your disorder, are the benefits of successful c-PTSD treatment.
- WebMD Editorial Contributors. “What to Know About Complex PTSD and Its Symptoms.” WebMD, 15 Apr. 2021, www.webmd.com/mental-health/what-to-know-complex-ptsd-symptoms.
- Hyland, Philip, et al. “Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder inDSM-5andICD-11: Clinical and Behavioral Correlates.” Journal of Traumatic Stress, vol. 31, no. 2, Wiley-Blackwell, Apr. 2018, pp. 174–80. https://doi.org/10.1002/jts.22272.
- Leonard, Jayne. “What Is Complex PTSD: Symptoms, Treatment, and Resources to Help You Cope.” Medical News Today, 23 Dec. 2022, www.medicalnewstoday.com/articles/322886.
- Maercker, Andreas, et al. “Complex Post-traumatic Stress Disorder.” The Lancet, vol. 400, no. 10345, Elsevier BV, July 2022, pp. 60–72. https://doi.org/10.1016/s0140-6736(22)00821-2.
- Berle, David. “What Is Complex PTSD and How Does It Relate to Past Abuse and Trauma?” The Conversation, theconversation.com/what-is-complex-ptsd-and-how-does-it-relate-to-past-abuse-and-trauma-172497.
- “ICD-11 for Mortality and Morbidity Statistics.” World Health Organization (WHO), icd.who.int/browse11/l-m/en#/http%253a%252f%252fid.who.int%252ficd%252fentity%252f585833559. Accessed 27 Mar. 2023.
- Karatzias, Thanos T., et al. “PTSD and Complex PTSD: ICD-11 Updates on Concept and Measurement in the UK, USA, Germany and Lithuania.” European Journal of Psychotraumatology, vol. 8, no. sup7, Taylor and Francis, Jan. 2017, https://doi.org/10.1080/20008198.2017.1418103.
- U.S. Department of Veterans Affairs. “PTSD: National Center for PTSD.” VA.gov, 6 Oct. 2022, www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp.
- Wolf, Erika J., et al. “ICD–11 Complex PTSD in U.S. National and Veteran Samples.” Clinical Psychological Science, vol. 3, no. 2, SAGE Publishing, Mar. 2015, pp. 215–29. https://doi.org/10.1177/2167702614545480.
- Website, Nhs. “Complex PTSD – Post-traumatic Stress Disorder.” nhs.uk, www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/complex.
- Gillette, Hope. “Symptoms of Complex Post-Traumatic Stress Disorder (C-PTSD).” Psych Central, 10 Sept. 2021, psychcentral.com/ptsd/complex-posttraumatic-stress-disorder-symptoms#symptoms-and-signs.
- The Scottish Charity Regulator. “Complex PTSD (C-PTSD).” PTSD UK, www.ptsduk.org/what-is-ptsd/complex-ptsd. Accessed 27 Mar. 2023.
- Gilles, Gary. “Understanding Complex Post-Traumatic Stress Disorder.” Healthline, 29 Sept. 2018, www.healthline.com/health/cptsd#risk-factors.
- Williams, Monnica T., et al. “Assessing Racial Trauma Within a DSM–5 Framework: The UConn Racial/Ethnic Stress and Trauma Survey.” Practice Innovations, vol. 3, no. 4, American Psychological Association, Dec. 2018, pp. 242–60. https://doi.org/10.1037/pri0000076.
- Bremner, J. Douglas. “Traumatic Stress: Effects on the Brain.” Dialogues in Clinical Neuroscience, vol. 8, no. 4, Laboratoires Servier, Jan. 2006, pp. 445–61. https://doi.org/10.31887/dcns.2006.8.4/jbremner.
- Tull, Matthew, PhD. “What Is Complex PTSD (C-PTSD)?” Verywell Mind, 15 Feb. 2023, www.verywellmind.com/what-is-complex-ptsd-2797491.
- Courtois, C. A., and J. D. Ford. “Treating Complex Traumatic Stress Disorders: An Evidence-based Guide.” American Psychological Association, 2009, psycnet.apa.org/record/2009-04501-000.
- Neuroscience News. “CPTSD: A New Diagnosis Category in Post-traumatic Stress Disorder.” Neuroscience News, 1 July 2022, neurosciencenews.com/cptsd-psychology-20945.
- “PTSD Treatments.” American Psychological Association, July 2017, www.apa.org/ptsd-guideline/treatments.
- Nash, Stacey L. “What Is the Difference Between Complex PTSD and BPD?” Psych Central, 9 Sept. 2022, psychcentral.com/ptsd/how-ptsd-cptsd-and-bpd-can-impact-relationships#how-they-differ.
- GoodTherapy Editor Team. “Complex Posttraumatic Stress (C–PTSD) – Getting Help for C–PTSD.” GoodTherapy, 17 Sept. 2019, www.goodtherapy.org/learn-about-therapy/issues/complex-ptsd/getting-help.
- Lauretta, Ashley. “How Much Does Therapy Cost?” edited by Alena Hall, Forbes Health, 2021, https://www.forbes.com/health/mind/how-much-does-therapy-cost/
- “How Much Does EMDR Therapy Cost?” HowMuchIsIt.Org, 2018, https://www.howmuchisit.org/emdr-therapy-cost/
- Malka, Terez, MD. “How Much Do Antidepressants Cost? With and Without Insurance.” K Health, 3 Oct. 2022, khealth.com/learn/antidepressants/how-much-do-antidepressants-cost.
- Voorendonk, Eline M., et al. “Trauma-focused Treatment Outcome for Complex PTSD Patients: Results of an Intensive Treatment Programme.” European Journal of Psychotraumatology, vol. 11, no. 1, Taylor and Francis, July 2020, https://doi.org/10.1080/20008198.2020.1783955.
- Bongaerts, Hannelies, et al. “Intensive EMDR to Treat Patients With Complex Posttraumatic Stress Disorder: A Case Series.” Journal of Emdr Practice and Research, vol. 11, no. 2, May 2017, pp. 84–95. https://doi.org/10.1891/1933-3220.127.116.11.
- Howard, Alexandra, et al. “Prevalence and Treatment Implications of ICD-11 Complex PTSD in Australian Treatment-seeking Current and Ex-serving Military Members.” European Journal of Psychotraumatology, vol. 12, no. 1, Taylor and Francis, Feb. 2021, https://doi.org/10.1080/20008198.2020.1844441.
If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.
One of our friendly associates will help you get the help you need. Take this first step to feel better and take control.